Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update

Abstract

Non-immunoglobulin E-mediated gastrointestinal food allergic disorders (non-IgE-GI-FA) include food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE) and food protein-induced allergic proctocolitis (FPIAP), which present with symptoms of variable severity, affecting the gastrointestinal tract in response to specific dietary antigens. The diagnosis of non-IgE-GI-FA is made clinically, and relies on a constellation of typical symptoms that improve upon removal of the culprit food. When possible, food reintroduction should be attempted, with the documentation of symptoms relapse to establish a conclusive diagnosis. Management includes dietary avoidance, nutritional counselling, and supportive measures in the case of accidental exposure. The prognosis is generally favorable, with the majority of cases resolved before school age. Serial follow-up to establish whether the acquisition of tolerance has occurred is therefore essential in order to avoid unnecessary food restriction and potential consequent nutritional deficiencies. The purpose of this review is to delineate the distinctive clinical features of non-IgE-mediated food allergies presenting with gastrointestinal symptomatology, to summarize our current understanding of the pathogenesis driving these diseases, to discuss recent findings, and to address currents gaps in the knowledge, to guide future management opportunities.

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

“…Furthermore, there is a lack of laboratory tests to assist in diagnosis. In most cases non-IgE FA are diagnosed on the basis of compatible symptoms and the demonstration that symptoms disappear once the suspected food has been eliminated and reappear when it is reintroduced [ 5 ].…”

Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

“…Repeated episodes of incoercible vomiting, with possible severe dehydration, lethargy and diarrhea occurring within a few hours from CM intake, can be classified as food protein induced enterocolitis syndrome (FPIES) [63,64]. Diarrhea, poor feeding, vomiting, failure to thrive and malabsorption are reported in food protein enteropathy.…”

“…Diarrhea, poor feeding, vomiting, failure to thrive and malabsorption are reported in food protein enteropathy. Food protein induced allergic proctocolitis typically shows he presence of blood and mucous in the stools and mild diarrhea in otherwise well-appearing, often breastfed infants [28,[31][32][33]64].…”

'Diagnosing food protein‐induced enterocolitis syndrome'

“…Further classifications have been used for FPIES, based on a number of concepts, as follows: a) based on the severity of clinical manifestations into mild, moderate and severe for acute FPIES and in milder and severe forms for chronic FPIES 2 ; b) based on the age of the onset, in early, late and adult onset 3 ; c) based on the type of the trigger foods, in non‐solid food (cow's milk/soy) FPIES, solid food FPIES and multiple foods FPIES (ie when FPIES to multiple unrelated foods occurs) 3 and finally, d) based on the presence of specific IgE to the culprit food, in classic and atypical FPIES 2 . The classification scheme of FPIES is shown in Figure 1.…”

“…A subgroup of FPIES patients present positive skin prick test (SPT) and/or serum specific IgE (s‐IgE) to the trigger food, defined as atypical FPIES 2 . More details of this FPIES subtype are discussed in the allergy testing session.…”